The information for release / exchange is as follows:
Any and all Assessments, Progress Notes, and/or verbal exchanges between any and all aforementioned parties. This Release of Information will expire upon the date of Client Record closure with In One Peace LLC.
I understand that my records are protected under the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2 and that I must give permission for my behavioral care/counseling records to be released. I understand that my records are being forwarded to the aforementioned party/parties and the records may contain information about alcohol and/or drug abuse/use and I authorize such release of these records.
By signing below I understand that this Release of Information may be revoked by me in writing at any time and will expire one year from the date signed.